Laryngorhinootologie 2015; 94(S 01): S288-S305
DOI: 10.1055/s-0034-1398644
Referat
© Georg Thieme Verlag KG Stuttgart · New York

Minimal-invasive Chirurgie der vorderen Schädelbasis: Transorbitale Zugänge

Minimally Invasive Surgery of the Anterior Skull Base: Transorbital Approaches
H. G. Gassner
1   Universitätsklinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie der Universität Regensburg (Direktor: Prof. Dr. med. J. Strutz)
,
K.-M. Schebesch
2   Universitätsklinik und Poliklinik für Neurochirurgie der Universität Regensburg (Direktor: Prof. Dr. med. A. Brawawnski)
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
10. April 2015 (online)

Zusammenfassung

Minimal invasive Zugänge zur vorderen Schädelbasis haben in den letzten Jahrzehnten einen wichtigen Stellenwert erlangt. Für den HNO Bereich hat sich-in interdisziplinärer Kooperation-insbesondere das transnasal-endoskopische Vorgehen etabliert. Die jüngere Technik des transorbital-endoskopischen Vorgehens kann durch ein differierendes Spektrum an Zugangskorridoren eine Ergänzung des etablierten transnasal-endoskopischen Vorgehens darstellen. Ziel der vorliegenden Arbeit war die Bewertung der transorbital-endoskopischen Zugänge anhand der aktuellen Literatur.

Diese Zugänge stellen eine wesentliche Erweiterung der minimal invasiven Zugänge zur vorderen Schädelbasis dar. Wichtige Strukturen insbesondere der lateralen Aspekte der vorderen Schädelbasis einschließlich der Stirnhöhlenhinterwand lassen sich exzellent erreichen. Aufgrund ihrer geringen Morbidität und der kosmetisch exzellenten Ergebnisse ergänzen sie etablierte transnasale, transfaziale und transkranielle Zugänge zur vorderen Schädelbasis. Ihre Durchführung erfordert spezialisierte Kenntnisse okuloplastischer Operationstechniken des interdisziplinären Teams.

Abstract

Minimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplanary cooperation, endonasal endoscopic in particular approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors. The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature.

The transorbital approaches allow excellent exposure of difficult to reach areas like the the anterior and posterior wall of the frontal sinus; working angles may be more favorable and the paranasal sinus system can be preserved while exposing the base of skull. Because of their minimal morbidity and the cosmetically excellent results, the transorbital approaches represent an important addition to established endonasal endoscopic and open approaches to the anterior skull base. Their execution requires an interdisciplinary team approach.

 
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